Top Ten Questions

TOP TEN QUESTIONS FOR CHILD MENTAL HEALTH WORKERS TO CONSIDER FOR THEIR CLIENT GROUP REGARDING PSYCHOTROPIC DRUGS

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How can I best challenge the practice of prescribing psychotropic drugs to children with whom I co-work and about which I have ethical concerns?

Do the Safeguarding Guidelines of my workplace or professional body apply equally to this area of prescribed psychotropic drugs for children? If yes, do you feel you now have the ‘ethical legitamacy’ to challenge the practice of medical colleagues who are prescribing psychotropics to children with whom you work, where you fear harm will be done?

Has the informed consent of the young person and their parents been obtained prior to prescribing the psychotropic drugs?

Has the data used to make a ‘diagnosis’ been triangulated to maximise its reliability i.e. evidence based data obtained from the family, school + community as well as the medical practitioner?

Do you ever fulfill ‘the sleepless night criteria’ where your levels of anxiety regarding a child’s psychotropic medication interferes with your quality of sleep? What should you do the next working day if that is the case?

Do you think the right balance has been achieved between the Medical and Social models of understanding the many factors that contribute to a child’s situation in the case about which you have ethical concerns?

Have you ever asked about whether the child experiences any short, medium or long term side effects of the psychotropic drugs that cause you concern or investigated the possible consequences?

How often do you have appropriately challenging conversations with medical professionals about your professional concerns regarding the psychotropic drugs they are prescribing for children on your caseload?

Was the response of your medical colleague positive or negative to the professional challenge you made or what would you predict it to be?

Have you, as many Directors of Children’s Services demand, executed your paramount responsibility for Safeguarding Children in your current casework practice?

Please post your thoughts as comments or ask for clarification of any issues arising

I am a Chartered Educational Psychologist (BPS),who has seen the questionable practice of over-diagnosis and prescription of psychotropic drugs for children, increase exponentially in my thirty year career. I am a member of the Division of Educational and Child Psychologists Committee of the British Psychological Society. Now is the time to appropriately challenge doctors in cases where psychologists have ethical concerns about the Emotional Wellbeing of the children with whom they work. This is supported by the Health Professionals Council "Duties as a Registrant."(2009) = "You must not do anything or allow someone else to do something that you may have good reason to believe will put the health or safety of a service user in danger." We all therefore have a "Duty of Care to be Aware" of these issues in the schools where we work and to discuss concerns with a linkworker there and with the prescribing doctor. The National Committees of the Association of Educational Psychologists and the Division of Educational and Child Psychology of the British Psychological Society actively support my position of raising concerns about the impact of psychotropic drugs on the Safeguarding of Children in the U.K. from the potential short and longer term physical and psychological harm. I believe this is a key issue in promoting wellbeing of children within a progressive society. I was pleased to contribute to the BPS response to the American Psychiatric Association's consultation on DSM-5 and the paper was called "The Future of Psychiatric Diagnosis," (BPS 2012.)

3 Comments Already

Excellent and hopefully thought-provoking questions for practitioners, Dr. Traxon. May I suggest an eleventh, as a medical layman?

Is there any body of systematically organized and rigorously validated data from controlled, randomized double-blind trials, to document the range of outcomes and assess primary side effects of psychotropic medications used in children for periods exceeding six months? [and if so, where is it reported?]

ETHICAL LEGITIMACY = the right to challenge prescribing medics about over-prescription due to ethical guidance from Professional Bodies e.g. the HPC in the U.K. which states ” If you have a professional concern that another worker’s actions may do harm to a ‘Service User’ then you are ‘Duty Bound’ to act in a Safeguarding sense.”

Dr. Traxson, I think I was asking a somewhat different question. If there is no body of validated outcomes data in the long-term prescription of psychotropic drugs to children, then would not the issue be one of ethical and LEGAL “imperative” to challenge and confront the practice and to bar practitioners who continue it?